---
title: "Telemetry monitoring in hospitalized patients: indications, risks, and how to reduce overuse"
id: "cmaj-2-telemetry-monitoring-for-patients-admitted-to-hospital-practice"
canonical_url: "https://medichelpline.com/clinical-feed/cmaj-2-telemetry-monitoring-for-patients-admitted-to-hospital-practice"
content_type: "clinical_feed_article"
specialty: "Cardiology"
source_name: "CMAJ"
source_url: "http://www.cmaj.ca/cgi/content/short/198/28/E1113?rss=1"
published_at: "2026-08-10T04:05:21.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Telemetry monitoring in hospitalized patients: indications, risks, and how to reduce overuse
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/cmaj-2-telemetry-monitoring-for-patients-admitted-to-hospital-practice
- **Specialty:** [Cardiology](https://medichelpline.com/clinical-feed/cardiology.md)
- **Primary Source:** CMAJ
- **Source URL:** [Original Journal Publication](http://www.cmaj.ca/cgi/content/short/198/28/E1113?rss=1)
- **Published At:** 2026-08-10T04:05:21.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- **Telemetry** (continuous remote electrocardiographic monitoring) detects arrhythmias, abnormal QT intervals and ECG changes suggestive of myocardial ischemia, but is frequently ordered without an appropriate clinical indication. - Observational studies report that between **30% and 90%** of telemetry use outside critical care is inappropriate or continued longer than recommended. - Common inappropriate uses include monitoring patients with chronic, stable atrial fibrillation or asymptomatic, hemodynamically stable sinus bradycardia; such patients rarely have management-changing arrhythmias identified. - Recommended indications include patients at high risk of arrhythmia such as those with **acute coronary syndrome** or suspected **cardiac syncope**; other appropriate indications cited are acute stroke, drug overdose and significant electrolyte abnormalities. - For moderate-to-high–risk acute coronary syndrome, telemetry is advised for **24–48 hours** until evidence of modifiable ischemia or electrical instability is absent. For suspected cardiac syncope, at least **24 hours** of monitoring is recommended while cause and treatment are being determined. - The **American Heart Association** practice standards note there is no Level A evidence demonstrating benefit of telemetry in hospital settings. - Telemetry is not benign: monitoring leads can restrict patients; incidental or artifactual findings can trigger unnecessary tests or treatments; telemetry may contribute to delirium, alarm fatigue and higher health-care costs. - Interventions that reduce inappropriate telemetry include requiring clinicians to select a standards-based indication when ordering, targeted staff education, embedding expiration times in orders, and daily review of telemetry status. - Quality-improvement initiatives that standardize telemetry discontinuation have been shown to safely and sustainably reduce the duration of inappropriate monitoring without increasing mortality, code blue events or critical-care outreach activations. - Competing interests reported by authors include research grants to one author and a stipend to another for a stewardship role; no other competing interests were declared.
## Clinical Analysis & Structured Key Points
Telemetry monitoring for patients admitted to hospital | CMAJ Skip to main content Log in Toggle navigation menu Open settings menu Open search Advanced Search Advanced Search Log in --> Telemetry monitoring for patients admitted to hospital Max Silverman Max Silverman Department of Medicine (Silverman, Silverstein), University of Toronto, Toronto, Ont.; Section of Cardiology, Department of Medicine (Dhruva), University of California, San Francisco School of Medicine, San Francisco, Calif.; Division of General Internal Medicine (Silverstein), Sunnybrook Health Sciences Centre, Toronto, Ont. MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Sanket S. Dhruva Sanket S. Dhruva Department of Medicine (Silverman, Silverstein), University of Toronto, Toronto, Ont.; Section of Cardiology, Department of Medicine (Dhruva), University of California, San Francisco School of Medicine, San Francisco, Calif.; Division of General Internal Medicine (Silverstein), Sunnybrook Health Sciences Centre, Toronto, Ont. MD MHS Find this author on Google Scholar Find this author on PubMed Search for this author on this site and William K. Silverstein William K. Silverstein Department of Medicine (Silverman, Silverstein), University of Toronto, Toronto, Ont.; Section of Cardiology, Department of Medicine (Dhruva), University of California, San Francisco School of Medicine, San Francisco, Calif.; Division of General Internal Medicine (Silverstein), Sunnybrook Health Sciences Centre, Toronto, Ont. MD MSc Find this author on Google Scholar Find this author on PubMed Search for this author on this site CMAJ August 10, 2026 198 (28) E1113; DOI: https://doi.org/10.1503/cmaj.252113 PDF Help Article Responses Metrics PDF Electrocardiographic monitoring (telemetry) is often ordered without an appropriate clinical indication 1 Telemetry (continuous remote cardiac rhythm monitoring) can detect arrhythmias, abnormal QT intervals, and electrocardiographic changes suggestive of myocardial ischemia. 2 Studies show that between 30% and 90% of noncritical care telemetry use is inappropriate or is continued longer than recommended. 1 Patients monitored without an appropriate indication (such as chronic, stable atrial fibrillation or asymptomatic hemodynamically stable sinus bradycardia) rarely have arrhythmias identified that change management. 1 , 2 Inpatient telemetry is recommended for patients at high risk of arrhythmia, such those with as acute coronary syndrome or suspected cardiac syncope In patients with moderate to high risk of acute coronary syndrome, telemetry should be continued for 24 to 48 hours until there is no evidence of modifiable ischemia or electrical instability. 2 When cardiac syncope is suspected using clinical decision tools, a minimum of 24 hours of monitoring is warranted until cause and treatment is identified. Other indications include acute stroke, drug overdose, or substantial electrolyte abnormalities. The American Heart Association’s Practice Standards acknowledge no Level A evidence supporting the benefit of telemetry. 2 Telemetry is not benign Monitoring leads are physically restrictive for patients. Incidental or artifactual telemetry findings may lead to unnecessary diagnostic or therapeutic cascades. 1 Telemetry can also lead to delirium, alarm fatigue, and increased health care expenditures. 3 , 4 Mandates and staff education can improve appropriateness of telemetry ordering 1 , 4 Requiring clinicians to select a Practice Standards–based indication when ordering telemetry and providing education on appropriate reasons to order telemetry leads to substantial reductions in inappropriate telemetry orders without increasing mortality, code blue events, or activation rates of critical care outreach teams. 1 , 4 Embedding expiration times into telemetry orders or reviewing telemetry use daily are evidence-based interventions that facilitate timely discontinuation 4 , 5 Even when ordered for an appropriate indication, telemetry is often maintained for longer than is recommended. Quality-improvement initiatives that standardize discontinuation of telemetry into routine practice safely and sustainably reduce duration of inappropriate telemetry monitoring. 5 Footnotes Competing interests: Sanket Dhruva reports receiving research grants from the United States Department of Veterans Affairs and Arnold Ventures. William Silverstein reports receiving a stipend as lead of the Students and Trainees Advocating for Resource Stewardship, Choosing Wisely Canada. No other competing interests were declared. This article has been peer reviewed. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/ References 1 ↵ Silverstein WK Chang IY Sreenivasan S . Decreasing unnecessary use of continuous cardiac monitoring (telemetry) in hospitalised patients . BMJ 2024 ; 386 : e077499 . Google Scholar OpenURL CrossRef Full Text PubMed 2 ↵ Sandau KE Funk M Auerbach A . Update to practice standards for electrocardiographic monitoring in hospital settings: a scientific statement from the American Heart Association . Circulation 2017 ; 136 : e273 – 344 . Google Scholar OpenURL CrossRef Abstract / Full Text PubMed 3 ↵ Chen S Zakaria S . Behind the monitor — the trouble with telemetry: a teachable moment . JAMA Intern Med 2015 ; 175 : 894 . Google Scholar OpenURL PubMed 4 ↵ Yeow RY Strohbehn GW Kagan CM . Eliminating inappropriate telemetry monitoring: an evidence-based implementation guide . JAMA Intern Med 2018 ; 178 : 971 – 8 . Google Scholar OpenURL PubMed 5 ↵ Dressler R Dryer MM Coletti C . Altering overuse of cardiac telemetry in non–intensive care unit settings by hardwiring the use of American Heart Association guidelines . JAMA Intern Med 2014 ; 174 : 1852 – 4 . Google Scholar OpenURL PubMed PDF Previous Next Back to top In This Issue CMAJ Vol. 198, Issue 28 10 Aug 2026 Table of Contents Index by author Article tools Respond to this article Print Download PDF Article Alerts Alerts for this Article User Name * Password * To sign up for email alerts or to access your current email alerts, enter your email address below: Email * Email Article Email This Article Thank you for your interest in spreading the word on CMAJ. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Telemetry monitoring for patients admitted to hospital Message Subject (Your Name) has sent you a message from CMAJ Message Body (Your Name) thought you would like to see the CMAJ web site. Your Personal Message CAPTCHA Please verify that you are a real person Close Citation Tools Citation Tools Telemetry monitoring for patients admitted to hospital Max Silverman Max Silverman Sanket S. Dhruva Sanket S. Dhruva and William K. Silverstein William K. Silverstein CMAJ Aug 2026, 198 (28) E1113; DOI: 10.1503/cmaj.252113 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Request Permissions Share Share This Article Telemetry monitoring for patients admitted to hospital Max Silverman Max Silverman Sanket S. Dhruva Sanket S. Dhruva and William K. Silverstein William K. Silverstein CMAJ Aug 2026, 198 (28) E1113; DOI: 10.1503/cmaj.252113 Share This Article: Copy Post Like 0 Jump To Section Electrocardiographic monitoring (telemetry) is often ordered without an appropriate clinical indication1 Inpatient telemetry is recommended for patients at high risk of arrhythmia, such those with as acute coronary syndrome or suspected cardiac syncope Telemetry is not benign Mandates and staff education can improve appropriateness of telemetry ordering1,4 Embedding expiration times into telemetry orders or reviewing telemetry use daily are evidence-based interventions that facilitate timely discontinuation4,5 Footnotes References PDF Related Articles No related articles found. Google Scholar PubMed Cited By... No citing articles found. Google Scholar More in this TOC Section Spontaneous fibroid rupture and hemoperitoneum mimicking appendicitis in pregnancy Complex dorsal metacarpophalangeal joint dislocation in a 15-year-old boy Hospital-to-home transitions for children with medical complexity Pyoderma gangrenosum in a 26-year-old woman Left arm twitching caused by failure of pacemaker lead insulation Show more Practice Similar Articles Monitoring of ambulance patients by radio telemetry Funduscopic examination of patients with diabetes who are admitted to hospital Ottawa Hospital Patient Safety Study: incidence and timing of adverse events in patients admitted to a Canadian teaching hospital Asthma education and patient monitoring Risk of severe outcomes among patients admitted to hospital with pandemic (H1N1) influenza See More View all jobs > (this link will open in a new window) Post a job > (this link will open in a new window) Latest Jobs Public Health Physician and Associate Medical Director Vancouver, British Columbia Locum Pediatric Oncologist, Solid Tumor Oncology Ottawa, Ontario Vice President, Quality and Chief Medical Officer Negotiable within Alberta Associate Medical Officer of Health Thunder Bay, Ontario Regina, Saskatchewan Georgetown, Ontario Emergency Physician Bancroft, Ontario
## Related Clinical Research

- [Intensive blood pressure control linked to 15% lower 7-year dementia risk](https://medichelpline.com/clinical-feed/medical-news-today-0-intensive-blood-pressure-control-cuts-7-year-dementia-risk-by-15-study-finds.md)
- [Shingrix shingles vaccine associated with 9% lower cardiovascular burden over 7 years](https://medichelpline.com/clinical-feed/medical-news-today-0-shingles-vaccine-linked-to-9-lower-cardiovascular-burden-in-new-study.md)
- [Stepwise DAPT de-escalation vs standard DAPT after drug-coated balloon angioplasty in multivessel](https://medichelpline.com/clinical-feed/medrxiv-15-impact-of-stepwise-dual-antiplatelet-therapy-de-escalation-in-patients-with.md)
- [Shingrix shingles vaccine associated with modestly lower cardiovascular risk in natural-experiment](https://medichelpline.com/clinical-feed/stat-news-0-newer-shingles-vaccine-linked-to-lower-heart-disease-risk-natural-experiment.md)
- [Cardiometabolic pathways mediating the effect of educational attainment on cardiovascular disease:](https://medichelpline.com/clinical-feed/medrxiv-13-cardiometabolic-pathways-linking-genetically-proxied-educational-attainment-to.md)

## Navigation
- [← Back to Cardiology Feed](https://medichelpline.com/clinical-feed/cardiology.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.